Developing a Value-Based Purchasing Methodology for FQHCs/RHCs Consistent with Payment Reform

Dates: 2010-2012

State: Colorado

Client(s): CO Dept. of Health Care Policy and Financing

Services: Health Care & Public Health Planning, Training & Technical Assistance, Health Systems Transformation, Policy Development & Implementation

Technical Expertise: Primary Care, Safety Net, State and Local Public Health, Health Care Reform

Like many state Medicaid agencies, the Colorado Department of Health Care Policy and Financing (HCPF) is intersted in including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) in its payment reform efforts. HCPF engaged JSI to assist it in developing a payment methodology that would be consistent with Federal requirements for FQHC/RHC payment and its goal of moving toward a value-based payment model. The project had two components: identification of a methodology for implementing FHQC/RHC prospective payment system (PPO) payments in the Colorado Child Health Insurance Program (CHP+), and identification of a value-based payment methodology for use with FQHCs/RHCS in both Medicaid and CHP+. The Department wishes to provide incentives designed to improve health outcomes, patient satisfaction, patient access, and to contain costs. At the completion of the project, JSI provided the Department with information about methodological as well as practical considerations that will inform the development of a value-based payment methodology for FQHCs and RHCs.

The project activities included research into payment methodology options and considerations, engaging stakeholders in identifying potential measures, development of a PPS payment methodology for CHP+, and implementation of a pilot data collection process to understand system capacity and barriers at the Department, managed care organizations (MCO) and provider levels.

The project resulted in the implementation of a PPS payment methodology for FQHCs/RHCs under CHP+. The project findings are also informing the Department's development of a potential gain sharing payment methodology for use with FQHCs/RHCs.


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